Backup Documents 09/23/2014 Item #16D16 (HCE 203.14) July 2014—June 2015 HCE 203.14
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC. 1 6 IJ 1 6
CONTRACT
HOME CARE FOR THE ELDERLY PROGRAM
THIS CONTRACT is entered into between the Area Agency on Aging for Southwest Florida, Inc. (Agency) and
Collier County Board of County Commissioners, (Contractor), and collectively referred to as the "Parties." The term
Contractor for this purpose may designate a Vendor, Subgrantee or Subrecipient.
WITNESSETH THAT:
WHEREAS,the Agency has determined that it is in need of certain services as described herein; and
WHEREAS, the Contractor has demonstrated that it has the requisite expertise and ability to faithfully perform such
services as an independent Contractor of the Agency.
NOW THEREFORE, in consideration of the services to be performed and payments to be made, together with the
mutual covenants and conditions hereinafter set forth,the Parties agree as follows:
1. Purpose of Contract
The purpose of this contract is to provide services in accordance with the terms and conditions specified in this
contract including all attachments, forms, exhibits and references incorporated, which constitute the contract
document.
2. Incorporation of Documents within the Contract
The contract will incorporate attachments, proposal(s), state plan(s), grant agreements, relevant Department
handbooks, manuals or desk books and Master Contract number HM014, as an integral part of the contract,except to
the extent that the contract explicitly provides to the contrary. In the event of conflict in language among any of the
documents referenced above,the specific provisions and requirements of the contract document(s)shall prevail over
inconsistent provisions in the proposal(s) or other general materials not specific to this contract document and
identified attachments.
3. Term of Contract
This contract shall begin at twelve(12:00)A.M., Eastern Standard Time July 1,2014 or on the date the contract has
been signed by the last party required to sign it, whichever is later. It shall end at eleven fifty-nine (11:59) P.M.,
Eastern Standard Time June 30,2015.
4. Contract Amount
The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an
amount not to exceed $30.836.00, or the rate schedule, subject to the availability of funds. Any costs or services
paid for under any other contract or from any other source are not eligible for payment under this contract.
5. Renewals
By mutual agreement of the Parties,in accordance with s.287.058(1)(g),F.S.,the Agency may renew the contract
for a period not to exceed three years, or the term of the original contract,whichever is longer. The renewal price, or
method for determining a renewal price, is set forth in the bid,proposal, or reply. No other costs for the renewal may
be charged. Any renewal is subject to the same terms and conditions as the original contract and contingent upon
satisfactory performance evaluations by the Agency and the availability of funds.
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6. Official Payee and Representative (dames.Addresses. and Telephone Numbers): ii+ii
The Contractor name, as shown on page 1 of this Collier County Housing, Human and Veteran
p g Services
a. contract, and mailing address of the official payee to 3339 E Tamiami Trail,Building H
whom the payment shall be made is: Naples,FL 34112
Kimberly Grant,Director
The name of the contact person and street address where Collier County Housing, Human and Veteran
b' financial and administrative records are maintained is: 3339 E Tamiami Trail,
uilding H
Naples, FL 34112
Kimberly Grant, Director
The name, address, and telephone number of the Collier County Housing, Human and Veteran
c. representative of the Contractor responsible for Services
administration of the program under this contract is: 3339 E Tamiami Trail,Building H
Naples,FL 34112
(239)252-2273
Nancy Dean, Director of Finance
d The section and location within the Agency where Area Agency on Aging for Southwest Florida, Inc.
Requests for Payment and Receipt and Expenditure 15201 North Cleveland Avenue, Suite 1100
forms are to be mailed is: North Fort Myers,FL 33903
Marianne Lorini, Executive Director
e. The name, address, and telephone number of the Area Agency on Aging for Southwest Florida, Inc.
Contract Manager for this contract is: 15201 North Cleveland Avenue, Suite 1100
North Fort Myers,FL 33903
239-652-6900
Upon change of representatives(names,addresses,telephone numbers)by either party,notice shall be provided in
writing to the other party and the notification attached to the originals of this contract.
7. All Terms and Conditions Included:
This contract and its Attachments, I, III, VII, VIII, IX, X and any exhibits referenced in said attachments,
together with any documents incorporated by reference, contain all the terms and conditions agreed upon by the
Parties. There are no provisions,terms,conditions,or obligations other than those contained herein,and this contract
shall supersede all previous communications, representations or agreements, either written or verbal between the
Parties.
By signing this contract,the Parties agree that they have read and agree to the entire contract.
IN WITNESS THEREOF, the Parties hereto have caused this contract,to be executed by their undersigned officials
as duly authorized.
Contractor: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR
COUNTY COMMISSIONERS SOUTH WE':+�%�FL RIDA,INC.
SIGNED BY: 014'7t'
SIGNED.: •.
NAME: Stephen Y. Carnell NAME: RONALD LUCCHINO,PhD
TITLE: Public Services Administrator TITLE: BOARD PRESIDENT
rfr
DATE: July 31, 2014 DATE:
Federal Tax ID: 59-6000558
Fiscal Year Ending Date: 09/30
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• INDEX OF ATTACHMENTS
ATTACHMENT I
STATEMENT OF WORK 4
ATTACHMENT III
FUNDING SUMMARY .1 7
ATTACHMENT VII
HOME CARE FOR THE ELDERLY ANNUAL BUDGET and RATE SUMMARY 18
ATTACHMENT VIII
HOME CARE FOR THE ELDERLY INVOICE REPORT SCHEDULE 19
ATTACHMENT IX
REQUEST FOR PAYMENT 20
ATTACHMENT X
RECEIPT AND EXPENDITURE REPORT 21
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ATTACHMENT I
STATEMENT OF WORK
HOME CARE FOR THE ELDERLY PROGRAM
SECTION I: SERVICES TO BE PROVIDED
1.1 DEFINITION OF CONTRACT TERMS AND ACRONYMS
1.1.1 DEFINITIONS OF ACRONYMS
Adult Protective Services(APS)
Activities of Daily Living(ADL)
Assessed Priority Consumer List(APCL)
Community Care for Disabled Adults(CCDA)
Community Care for the Elderly(CCE)
Client Information and Registration Tracking System(CIRTS)
Department of Children and Families(DCF)
Home Care for Disabled Adults (HCDA)
Home Care for the Elderly(HCE)
Institutional Care Program(ICP)
Instrumental Activities of Daily Living(IADL)
Planning and Service Area(PSA)
1.1.2 PROGRAM SPECIFIC TERMS
Aging Out: The condition of reaching 60 years of age and being transitioned from the Department of
Children and Families (DCF) Services, Community Care for Disabled Adults (CCDA) or Home Care for
Disabled Adults(HCDA) services to the Department's community-based services.
Area Plan: A plan developed by the area agency on aging outlining a comprehensive and coordinated service
delivery system in its planning and service area in accordance with the Section 306 (42 U.S.C. 3026) of the
Older Americans Act and Department instructions. The Area Plan includes performance measures and unit
rates per service offered per county.
Area Plan Update: A revision to the area plan wherein the area agency on aging enters HCE program
specific data in the CIRTS. An update may also include other revisions to the area plan as instructed by the
Department.
Functional Assessment: A comprehensive, systematic, and multidimensional review of a person's ability to
remain independent and in the least restrictive living arrangement. DOEA Form 701B is used by case
managers to conduct the functional assessment.
1.2 GENERAL DESCRIPTION
1.2.1 General Statement
Area Agencies on Aging may contract with CCE lead agencies or other case management entities for the
provision of the HCE program. Approved caregivers receive a Basic Subsidy to reimburse some of their
expenses each month for caring for the consumer and may receive a Special Subsidy for other necessary
services and essential supplies. Caregivers may be approved for up to three HCE clients in their home.
1.2.2 Home Care for the Elderly Program Mission Statement
The Home Care for the Elderly Program supports family style living arrangements, on a non-profit basis, as an
alternative to nursing homes or other institutional care. Through the program,a caregiver for three or fewer elders
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living in a private home provides basic services of maintenance and supervision as well as coordinating other
necessary specialized services.
1.2.3 Authority
The relevant authority governing the HCE program include:
(1) Rule Chapter 58H-1, Florida Administrative Code; and
(2) Sections 430.601 through 430.608,F.S.
1.2.4 Scope of Service
The Contractor is responsible for the programmatic, fiscal, and operational management of HCE. The
program services shall be provided in a manner consistent with and described in the Contractor's Request for
Proposal, RFP, and the Agency's current area plan and the current Department of Elder Affairs Programs
and Services Handbook, located on the DOEA website,http://elderaffairs.state.fl.us/doea/nois.php.
1.2.5 Major Program Goals
The major goals of the HCE program are to ensure that:
(1) Basic Subsidy is provided to the caregiver of each client and
(2) Special Subsidy is provided when essential to the well-being of the client.
1.3 INDIVIDUALS TO BE SERVED
1.3.1 General Eligibility
The Home Care for the Elderly program serves elders age 60 and older at risk of placement in a nursing
home or other institutional settings who can remain in a family style setting through the provision of
subsidies.
1.3.2 Client Eligibility
Clients eligible to receive services under this contract must:
(1) Be 60 years of age or older;
(2) Have income no greater than the Institutional Care Program(ICP) standard;
(3) Meet the ICP asset limitation;
(4) Be at risk of nursing home placement;
(5) Have an approved adult caregiver living in the home with them who is willing and able to provide
care or assist in arranging for care; and
(6) Not be enrolled in a Medicaid capitated long-term care program.
1.3.3 Caregiver Eligibility
Caregivers eligible to receive services under this contract must:
(1) Be at least 18 years of age;
(2) Be capable of providing a family-type living environment;
(3) Be a relative or a friend who has been accepted by the client as a surrogate family or is a responsible
adult with whom the client has made an arrangement to provide home care services;
(4) Be willing to accept responsibility for the social,physical and emotional needs of the care recipient;
(5) Be physically present and live in the home to provide supervision and to assist in arrangement of services
for the client;
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(6) Maintain the residential dwelling free of conditions that pose an immediate threat to the life, safety,
health and well-being of the home care client; and
(6) Be without record of conviction of abuse,neglect or exploitation of another person.
1.3.4 Targeted Groups
Priority for services provided under this contract shall be given to those eligible persons assessed to be at
risk of placement in an institution.
SECTION II: MANNER OF SERVICE PROVISION
2.1 SERVICE TASKS
To achieve the goals of the HCE program, the Contractor shall perform or ensure the performance of its
Subcontractors, for the following tasks:
(1) Client Eligibility Determination;
(2) Assessment and Prioritization of Service Delivery for New Clients;
(3) Delivery of Services to Eligible Clients; and
(4) Monitoring the performance of its Subcontractors.
2.1.1. Client Eligibility Determination
The Contractor shall ensure that applicant data is evaluated to determine eligibility. Eligibility to become a
client is based on meeting the requirements in ATTACHMENT I, Section 1.3.
2.1.2 Assessment and Prioritization of Service Delivery for New Clients
The Contractor shall ensure the following criteria are used to prioritize new clients for service delivery. It is
not the intent of the Agency to remove existing clients from any services in order to serve new clients
being assessed and prioritized for service delivery.
2.1.2.1 Priority Criteria for Service Delivery:
(1) Individuals in nursing homes under Medicaid who could be transferred to the community;
(2) Individuals in nursing homes whose Medicare coverage is exhausted and may be diverted to the
community;
(3) Individuals in nursing homes that are closing and can be discharged to the community; or
(4) Individuals whose mental or physical health condition has deteriorated to the degree self-care is not
possible;there is no capable caregiver, and institutional placement will occur within 72 hours;
(5) For the purpose of transitioning individuals receiving Community Care for Disabled Adults (CCDA)
and Home Care for Disabled Adults(HCDA)services through the Department of Children and Families
(DCF) Adult Services to community-based services provided through the Department, when services
are not currently available, area agency on aging staff and lead agency case managers shall ensure that
"Aging Out" individuals are prioritized for services only after Adult Protective Services (APS) High
Risk and Imminent Risk individuals.
2.1.2.2 Priority Criteria for Service Delivery for Other Assessed Individuals:
The assessment and provision of services should always consider the most cost effective means of service
delivery. Functional impairment shall be determined through the Agency's consumer assessment form
administered to each applicant. The most frail individuals not prioritized above will receive services to the
extent funding is available.
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2.1.3 Delivery of Services to Eligible Clients 1 6 ® 1
6
The Contractor shall ensure the provision of a continuum of services that meet the diverse needs of the •L
functionally impaired elders and their caregivers. The Contractor shall ensure Basic Subsidy and Special
Subsidy services are performed in accordance with the current Department of Elder Affairs Programs and
Services Handbook.
2.1.3.1 Basic Subsidy
The Basic Subsidy is a cash payment made to an approved caregiver each month to reimburse some expenses
incurred in caring for the client. The Basic Subsidy is provided for support and maintenance of the care
recipient, including housing, food, clothing, and medical costs not covered by Medicaid, Medicare or any
other insurance. A Basic Subsidy shall be paid to approved caregivers when the client is in the home for any
part of the month. If the client is hospitalized or in any other temporary institution for 30 days or less, the
full Basic Subsidy shall be provided to the caregiver as if the client were in the home.
2.1.3.1.1 Calculating the Basic Subsidy
The Basic Subsidy shall be based on the financial status of the client receiving care. In the event that both
a husband and wife are clients,their combined financial status shall be used to determine the amount of the
Basic Subsidy.
2.1.3.2 Special Subsidy Services
Though every eligible HCE client receives a Basic Subsidy, Special Subsidy payments are pre-authorized and
are based on additional specialized medical or health care services, supplies or equipment needed to maintain
the health and well-being of the individual elder. The Special Subsidy for additional medical support and
special services is a cash payment to reimburse the costs of any other service or special care not covered by
Medicaid, Medicare, or private insurance when these services are determined to be essential to maintain the
well-being of the home care recipient. A Special Subsidy shall be paid to the approved caregivers when the
client is in the home for any part of the month. Special Subsidy Services may be authorized through a vendor
agreement.All Special Subsidy services must be performed in accordance with the Department of Elder Affairs
Programs and Services Handbook. Special Subsidy services include:
(1) Adult Day Care; (13) Material Aid;
(2) Adult Day Health Care; (14) Occupational Therapy;
(3) Caregiver Training/Support; (15) Other;
(4) Chore; (16) Outreach;
(5) Chore(Enhanced); (17) Personal Care;
(6) Counseling(Gerontological); (18) Physical Therapy;
(7) Counseling(Mental Health/Screening); (19) Respite(Facility Based or In-Home);
(8) Home Delivered Meals; (20) Skilled Nursing Services;
(9) Home Health Aide Service; (21) Specialized Medical Equipment, Services and Supplies;
(10) Homemaker; (22) Speech Therapy; and
(11) Housing Improvement; (23) Transportation.
(12) Vendor Payment;
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2.1.3.3 ACCESS TO AND COORDINATION OF SERVICES 1 6 D 1 6
The contractor shall ensure through case management and case aide services, that the HCE clients' needs
are documented and needed services are planned, arranged and coordinated for the client and caregiver.
2.1.4 Use of Subcontractors
If this contract involves the use of a Subcontractor or a third party,then the Contractor shall not delay the
implementation of its agreement with the Subcontractor. If any circumstances occur that may result in a
delay for a period of 60 days or more of the initiation of the subcontract or in the performance of the
Subcontractor, the Contractor shall notify the Contract Manager and the Agency's Chief Financial
Officer in writing of such delay.
2.1.4.1 The Contractor shall not permit a Subcontractor to perform services related to this agreement without
having a binding Subcontractor agreement executed. In accordance with Section 23.1 of the Master
Contract, the Agency will not be responsible or liable for any obligations or claims resulting from such
action.
2.1.4.2 Monitoring the Performance of Subcontractors
The Contractor shall monitor at least once per year each of its Subcontractors, Subrecipients, Vendors
and/or Consultants paid from funds provided under this contract. The Contractor shall perform fiscal,
administrative and programmatic monitoring to ensure contractual compliance, fiscal accountability,
programmatic performance, and compliance with applicable state and federal laws and regulations. The
Contractor shall monitor to ensure that time schedules are met, the budget and scope of work are
accomplished within the specified time periods and other performance goals stated in this contract are
achieved.
2.2. SERVICE TIMES
2.2.1 Service Times
The Contractor shall ensure the services listed in this contract are available at times appropriate to meet
client service needs at a minimum, during normal business hours. Normal business hours are defined as
Monday through Friday, 8:00am to 5:00pm.
2.3 DELIVERABLES
2.3.1 Service Unit
The Contractor shall ensure the provision of the services described in the contract in accordance with the
current Department of Elder Affairs Programs and Services Handbook and the service tasks described in
Section 2.1. The chart below lists the types of services allowed and the unit of measurement. Units of
service will be paid pursuant to the rate established in the Area Plan as updated and shown in
ATTACHMENT VII and approved by the Agency's reporting requirements.
Remainder of page intentionally left blank
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Service Unit of Service
Case Aide Housing Improvement
Case Management Physical Therapy Hour
Chore Respite(Facility Based or In-Home)
Homemaker Other
Personal Care
Material Aid Episode
Specialized Medical Equipment, Services and Supplies
Transportation One-Way Trip
2.4 REPORTS
The Contractor shall respond to additional routine and/or special requests for information and reports
required by the Agency in a timely manner as determined by the Contract Manager.The Contractor shall
establish due dates for any Subcontractors that permits the Contractor to meet the Agency's reporting
requirements.
2.4.1 Client Information and Registration Tracking System (CIRTS)Reports
The Contractor shall input HCE specific data into CIRTS to ensure CIRTS data accuracy. The Contractor
shall use CIRTS generated reports which include the following:
(1) Client Reports;
(2) Monitoring Reports;
(3) Services Reports;
(4) Miscellaneous Reports;
(5) Fiscal Reports;
(6) Aging and Disability Resource Center Reports; and
(7) Outcome Measurement Reports.
2.5 RECORDS AND DOCUMENTATION
The Contractor shall ensure the collection and maintenance of client and service information on a
monthly basis from the Client Information and Registration Tracking System(CIRTS)or any such
system designated by the Agency. Maintenance includes valid exports and backups of all data and
systems according to Agency standards.
2.5.1 The Contractor must ensure all data for HCE subsidies are entered in the Client Information and Registration
Tracking System(CIRTS)by the 15th of each month. HCE subsidy data entered into the CIRTS by the 15th
of the month will be for payments incurred between the 16th of the previous month and the 15th of the current
month. Case management data entered into the CIRTS by the 9th of the month will be for units of service
provided during the previous month from the 1st and up to and including the last day of the month. The
Contractor will ensure data entry for HCE subsidies will cease on the 15th of the month and the CIRTS
Monthly Service Utilization Report, by consumer and by worker identification is generated, verified,
corrected, certified and submitted to the Agency no later than the 20th of the month along with copies of
receipts/services over$150.
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2.5.2 The Contractor and each Subcontractor, among other requirements, must anticipate and prepare for the loss
of information processing capabilities. The routine backing up of all data and software is required to recover
from losses or outages of the computer system. Data and software essential to the continued operation of
Contractor functions must be backed up. The security controls over the backup resources shall be as stringent
as the protection required of the primary resources. It is recommended that a copy of the backed up data be
stored in a secure, offsite location. The Contractor shall maintain written policies and procedures for
computer system backup and recovery and shall have the same requirement in its contracts and/or agreements
with Subcontractors. These policies and procedures shall be made available to the Agency upon request.
2.6 PERFORMANCE SPECIFICATIONS
2.6.1 Outcomes
(1) The Contractor shall ensure services provided under this contract are in accordance with the current
DOEA Programs and Services Handbook;
(2) The Contractor shall timely submit to the Agency all reports described in SECTION 2.4,
REPORTS; and
(3) The Contractor shall timely submit to the Agency all information described in SECTION 2.5,
RECORDS AND DOCUMENTATION.
2.6.2 The Contractor shall develop and document strategies in the Area Plan to support performance achievement
of the following:
(1) Percent of most frail elders who remain at home or in the community instead of going into a nursing
home;
(2) Average monthly savings per consumer for home and community-based care versus nursing home care
for comparable group clients;
(3) Percent of elders assessed with high or moderate risk environments who improved their environment
score;
(4) Percent of new service recipients with high-risk nutrition scores whose nutritional status improved;
(5) Percent of new service recipients whose ADL assessment score has been maintained or improved;
(6) Percent of new service recipients whose IADL assessment score has been maintained or improved;
(7) Percent of family and family-assisted caregivers who self-report they are likely to provide care;
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(8) Percent of caregivers whose ability to provide care is maintained or improved after one year of service
intervention(as determined by the caregiver and the assessor); and
(9) Percent of customers who are at imminent risk of nursing home placement who are served with
community based services;
The Contractor's performance of these measures will be documented in the Agency's annual monitoring
reports.
2.7 CONTRACTOR'S FINANCIAL OBLIGATIONS
Subsidy payments for each client and for the program overall must be maintained within the amount of
program funding available.
2.8 AGENCY RESPONSIBILITIES
2.8.1 Program Guidance and Technical Assistance
The Agency will provide to the Contractor guidance and technical assistance as needed to ensure the
successful fulfillment of the contract by the Contractor.
2.8.2 Contract Monitoring
The Agency will review and evaluate the performance of the Contractor under the terms of this contract.
Monitoring shall be conducted through direct contact with the Contractor through telephone, in writing, or
an onsite visit. The Agency's determination of acceptable performance shall be conclusive. The Contractor
agrees to cooperate with the Agency in monitoring the progress of completion of the service tasks and
deliverables. The Agency may use, but is not limited to, one or more of the following methods for
monitoring:
(1) Desk reviews and analytical reviews;
(2) Scheduled, unscheduled and follow-up on-site visits;
(3) Client visits;
(4) Review of independent auditor's reports;
(5) Review of third-party documents and/or evaluation;
(6) Review of progress reports;
(7) Review of customer satisfaction surveys;
(8) Agreed-upon procedures review by an external auditor or consultant;
(9) Limited-scope reviews; and
(10) Other procedures as deemed necessary.
SECTION III: METHOD OF PAYMENT
3.1 General Statement of Method of Payment
The method of payment for this contract includes advances,cost reimbursement for administration costs,and
fixed rate for services. The Contractor shall ensure fixed rates for services include only those costs that are
in accordance with all applicable state and federal statutes and regulations and are based on audited historical
costs in instances where an independent audit is required. The Contractor shall consolidate all requests for
payment from Subcontractors and expenditure reports that support requests for payment and shall submit to
the Agency on forms 106H (ATTACHMENT IX) and 105H(ATTACHMENT X).
3.1.1 The Contractor agrees to distribute funds as detailed in the area plan update and the Budget Summary,
ATTACHMENT VII to this contract. To request a budget line item change between the budget categories
of Case Management and Subsidies,the Contractor must submit the request in writing with a revised contract
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budget and receive written approval from the Agency's Contract Manager. Any changes in the total
amounts of the funds identified on the Budget Summary form require a contract amendment.
3.2 Advance Payments
3.2.1 The Contractor may request up to two months of advances at the start of the contract period to cover program
administrative and service costs. The payment of an advance will be contingent upon the sufficiency and
amount of funds released to the Agency and the Department by the State of Florida("budget release"). The
Contractor shall provide the Contract Manager documentation justifying the need for an advance and
describing how the funds will be distributed.
3.2.2 The Contractor's requests for advance require the approval of the Contract Manager. If sufficient budget is
available,the Agency will issue approved advance payments after July 1,2014.
3.2.3 All advance payments made to the Contractor shall be returned to the Agency as follows: one-
tenth of the advance payment received shall be reported as advance recoupment on each request for
payment, starting with report number five (5), in accordance with the invoice schedule as shown on
ATTACHMENT VIII to this contract.
3.2.4 The Contractor may temporarily place advanced funds in a FDIC insured interest bearing account.All interest
earned on contract fund advances must be returned to the Agency within thirty (30) days of the end of
each quarter of the contract period.
3.3 Invoice Submittal and Requests for Payment
All requests for payment documentation and expenditure reports submitted to support requests for payment
shall be on DOEA forms 106H (ATTACHMENT IX) and 105H (ATTACHMENT X). The Contractor
shall include with its request for payment documentation of services provided,the units of services provided,
and the rates for the services provided in conformance with the requirements as described in the deliverables
and service tasks.
3.3.1 Remedies for Nonconforming Services
The Contractor shall ensure that all goods and/or services provided under this contract are delivered timely,
completely and commensurate with required standards of quality. Such goods and/or services will only be
delivered to eligible program participants.
3.3.2 If the Contractor fails to meet the prescribed quality standards for services, such services will not be reimbursed
under this contract. In addition, any nonconforming goods (including home delivered meals) and/or services not
meeting such standards will not be reimbursed under this contract. The Contractor's signature on the request for
payment form certifies maintenance of supporting documentation and acknowledgement that the Contractor shall
solely bear the costs associated with preparing or providing nonconforming goods and/or services. The
Agency requires immediate notice of any significant and/or systemic infractions that compromise the quality,
security or continuity of services to clients.
3.3.3 Financial Consequences
Contractor shall ensure the provision of services to the projected number of clients in accordance with the Area
Plan as updated and within the contract amount. The Contractor shall ensure expenditure of 100% of the
contract amount budgeted for services to clients at the unit rates established in the Area Plan. In the event the
Contractor has a surplus of 1% or more at the end of the contract term, the Agency will reallocate 1% of the
budget for the next year contract term to other area agencies found to be serving clients to the fullest extent of
their allocated budgets. If, or to the extent, there is any conflict between this paragraph and paragraphs 39
and 39.1 of the Master Contract,this paragraph shall have precedence.
3.3.4 All payment requests shall be based on the submission of actual monthly expenditure reports beginning with
the first month of the contract. The schedule for submission of advance requests and invoices is
ATTACHMENT VIII to this contract.
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3.3.5 Any payment due by the Agency under the terms of this contract may be withheld pending the receipt and
approval by the Agency of all financial and programmatic reports due from the Contractor and any
adjustments thereto, including any disallowance not resolved as outlined in section 26 of this contract.
3.3.6 Payment may be authorized only for allowable expenditures, which are in accordance with the limits
specified in ATTACHMENT VII, Budget Summary.
3.3.7 Date For Final Request For Budget Revisions
Final requests for budget revisions or adjustments to contract funds based on expenditures for services
provided through June 25,2015, must be submitted to the Contract Manager no later than June 25, 2015.
3.3.8 Date for Final Request for Payment
The final request for payment is due to the Contract Manager no later than August 1,2015.
3.4 Consequences for Non-Compliance
The Contractor shall ensure 100%of the deliverables identified in Section 1.2.4. Scope of Services are
performed pursuant to contract requirements, and as described in Section 2.3., Deliverable in this
contract. If at any time the Contractor is notified by the Agency's Contract Manager that it has
failed to correctly, completely,or adequately perform these major deliverables,the Contractor will have
10 days to submit a Corrective Action Plan ("CAP") to the Contract Manager that addresses the
identified deficiency and states how the deficiency will be remedied within a time period approved by
the Contract Manager. The Agency shall assess a financial consequence for non-compliance on the
Contractor for each deficiency identified in the CAP which is not corrected pursuant to the CAP. The
Agency may also assess a financial consequence for failure to timely submit a CAP. In the event
Contractor fails to correct an identified deficiency within the approved time period specified in the CAP,
the Agency shall deduct, from the payment of the invoice for the following month, 1% of the
monthly value of the administrative funds in the contract for each day the deficiency is not corrected.
The Agency may also deduct, from the payment of the invoice for the following month, 1% of the
monthly value of the administrative funds in the contract for each day the Contractor fails to timely
submit a CAP, beginning the 11th day after notification by the Contract Manager of the deficiency. If,
or to the extent, there is any conflict between this paragraph and paragraphs 39 and 39.1 of the Master
Contract,this paragraph shall have precedence.
3.5 Documentation for Payment
The Contractor shall maintain documentation to support payment requests that shall be available to the
Agency or authorized individuals, such as Department of Financial Services,upon request.
3.5.1 The Contractor must ensure all data for HCE subsidies are entered in the Client Information and Registration
Tracking System(CIRTS)by the 15th of each month. HCE subsidy data entered into the CIRTS by the 15th
of the month will be for payments incurred between the 16th of the previous month and the 15th of the current
month. Case management data entered into the CIRTS by the 9th of the month will be for units of service
provided during the previous month from the 1st and up to and including the last day of the month. The
Contractor will ensure data entry for HCE subsidies will cease on the 15th of the month and the CIRTS
Monthly Service Utilization Report, by consumer and by worker identification is generated, verified,
corrected, certified and submitted to the Agency no later than the 20th of the month along with copies of
receipts/services over$150.
13
July 2014—June 2015 HCE 203i4
6D1
3.5.2 The Agency requires the Contractor to enter all required data per the Department's CIRTS Policy
Guidelines for clients and services in the CIRTS database. The data must be entered into the CIRTS before
the Contractor submits their request for payment and expenditure reports to the Agency. The
Agency shall establish time frames to assure compliance with due dates for the requests for payment and
expenditure reports to the Agency.
3.5.3 The Contractor must run monthly CIRTS reports and verify client and service data in the CIRTS is
accurate. This report must be submitted to the Agency with the monthly request for payment and
expenditure report and must be reviewed by the Agency before the Contractor's request for payment and
expenditure reports can be approved by the Agency.
Remainder of page intentionally left blank
16
• July 2014—June 2015 HCE 203.14 16 016
ATTACHMENT III
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS
CONTRACT CONSIST OF THE FOLLOWING:
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL FEDERAL AWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED
PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: N/A
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL STATE AWARD $0
STATE FINANCIAL ASSISTANCE SUBJECT TO Sec. 215.97, F.S.
PROGRAM TITLE FUNDING SOURCE CSFA AMOUNT
Home Care for the Elderly General Revenue-Collier 65010 $30,836.00
TOTAL AWARD $30,836.00
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED
PURSUANT TO THIS CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL ASSISTANCE
Section 215.97, Fla. Stat.
Chapter 69I-5, Fla.Admin. Code
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July 2014—June 2015 HCE 201146 0 16
ATTACHMENT VII
HOME CARE FOR THE ELDERLY PROGRAM
BUDGET SUMMARY
Collier County Board of County Commissioners
Collier
HCE Case Management/Case Aide $ 2,400.00
HCE Basic and Special Subsidies 28,436.00
Total $ 30,836.00
RATE SUMMARY
Collier County Board of County Commissioners
Collier
SERVICES REIMBURSEMENT RATE
Collier
Case Management $60.00
Case Aide $33.88
18
16016
- July 2014—June 2015 HCE 203.14
ATTACHMENT VIII
HOME CARE FOR THE ELDERLY
INVOICE SCHEDULE
Report Number Based On Submit to Agency on this Date
1 July Advance* July 1
2 August Advance* July 1
Monthly Utilization Report(7/1-7/15) July 20
3 July Expenditure Reports (105 & 106) August 9
Monthly Utilization Report(7/16-8/15) August 20
4 August Expenditure Report(105 & 106) September 9
Monthly Utilization Report (8/16-9/15) September 20
5 September Expenditure Report(105 & 106) October 9
Monthly Utilization Report (9/16-10/15) October 20
6 October Expenditure Report (105 & 106) November 9
Monthly Utilization Report(10/16-11/15) November 20
7 November Expenditure Report(105 & 106) December 9
Monthly Utilization Report (11/16-12/15 December 20
8 December Expenditure Report (105 & 106) January 9
Monthly Utilization Report(12/16-1/15) January 20
9 January Expenditure Report (105 & 106) February 9
Monthly Utilization Report(1/16-2/15) February 20
10 February Expenditure Report(105 & 106) March 9
Monthly Utilization Report(2/16-3/15) March 20
11 March Expenditure Report(105 & 106) April 9
Monthly Utilization Report (3/16-4/15) April 20
12 April Expenditure Report (105 & 106) May 9
Monthly Utilization Report(4/16-5/15) May 20
13 May Expenditure Report(105 & 106) June 9
Monthly Utilization Report (5/16-6/15) June 20
14 June Expenditure Report (105 & 106) July 9
Monthly Utilization Report(6/15-6/30) July 20
15 Final Expenditure Report (105 & 106) August 1
16 Closeout Report (105 & 106) August 15
Legend: * Advance based on projected cash need.
Note # 1: Report #1 for Advance Basis Contracts cannot be submitted to the Area Agency on Aging
for Southwest Florida, Inc.prior to July 1 or until the contract with the Agency has been
executed and a copy sent to the Agency on Aging for Southwest Florida, Inc. Actual submission
of the vouchers to the Agency is dependent on the of the expenditure report.
Note # 2: All advance payments made to the Contractor shall be returned to the Agency as follows: one—tenth
of the advance payment received shall be reported as an advance recoupment on each request for
payment, starting with report number five. The adjustment shall be recorded in Part C, Line I of
the report(ATTACHMENT X).
Note#3: Submission of expenditure reports may or may not generate a payment request. If final expenditure
report reflects funds due back to the Agency, payment is to accompany the report.
19
July 2014-June 2015 HCE10 ° 16
ATTACHMENT IX
REQUEST FOR PAYMENT
HOME CARE FOR THE ELDERLY PROGRAM
RECIPIENT NAME,ADDRESS,PHONE#and FEID# TYPE OF PAYMENT: This Request Period: From: To
Regular Contract Period
Contract#
Advance Report#
PSA#
CERTIFICATION: (hereby certify to the best of my knowledge that this request is complete and correct and conforms with the terms and the purposes of the above contract.
Prepared by: Date: Approved by: Date:
PART A:BUDGET SUMMARY AAAAdmin. Case Management Subsidies TOTAL
1.Approved Contract Amount $0.00 $000 $0.00 $0.00
2.Previous Funds Received for Contract Period $0.00 $0.00 $0.00 $0.00
3.Contract Balance(line 1 minus line 2) $0.00 $0.00 $0.00 $0.00
4.Previous Funds Requested and Not Received for Contract Period $000 $0.00 $0.00 $0.00
5.CONTRACT BALANCE dine 3 minus line 4) $0.00 $0.00 $0.00 $0.00
PART B:CONTRACT FUNDS REQUEST
1.Anticipated Cash Need(1st2nd months) $0.00 $0.00 $0.00 $0.00
2.Net Expenditures For Month $0.00 $000 $0.00 $0.00
(DOEA Form 10511 Part B,Line 4)
3.T0TAL $000 $0.00 $0.00 $0.00
PART C: NET FUNDS REQUESTED
1.Less Advance Applied $000 $000 $000 $0.03
2 TOTAL FUNDS REQUESTED(Part B Line 3,minus Part C Line 1) $0.00 $0.00 $0.00 $0.00
List of Services/Units/Rates provided See attached report.
DOEA FORM 106H
Revised 5/4/12
20
July 2014-June 2015 HCE 203.14 1 6 El
16
ATTACHMENT X
RECEIPT AND EXPENDITURE REPORT HOME CARE
FOR THE ELDERLY PROGRAM
PROVIDER NAME,ADDRESS,PHONE#and FEID# Program Funding: THIS REPORT PERIOD:
From To
AAAAdmin. CONTRACT PERIOD:
Case Management CONTRACT#
Subsidies: REPORT#
Basic
Spedal PSA#
CERTIFICATION. I certify to the best of my knowledge and belief that the report is complete and correct and all outlays
herein are for purposes set forth in the contract.
Prepared by: Date: Approved by: Date:
PART A:BUDGETED INCOMEI RECEIPTS 1.Approved 2.Actual Receipts 3.Total Receipts 4. Percent of
Budget For This Report Year to Date Approved Budget
1.State Funds $0.00 $0.00 $0.00 #DIV/0!
2. TOTAL RECEIPTS $0.00 $000 $0.00 #DIV/0 1
PART B:EXPENDITURES 1.Approved 2. Expenditures 3.Expendtures 4. Percent of
Budget For This Report Year to Date Approved Budget
1.AAA ProgramAdmiristration $0.00 $0.00 $0.00 #DIV/0!
2.Service Subcontractors: Case Management $0.00 $0.00 $0.00 #DIV/0 1
3.Service Subcontractors: Subsidy $0.00 $0.00 $0.00 #DIV/0 1
a.Basic Subsidy $0.00 $0.00 $0.00 #DIV/0!
b.Special Subsidy $0.00 $0.00 $0.00 #DIV/0!
4.TOTAL EXPENDITURES $0.00 $0.00 $0.00 #DIV/0!
PART C:OTHER REVENUEAND EXPENDITURES
I.Irterest: II.Advance Recoupment
1 Earned onGR Advance$
2.Return of GR Advance $ 1.Advance Recouped$
3.Other Earned $
DOE;FORM 105H
Revised 5/2512010
21
16016
Attestation Statement
Agreement/Contract Number HCE 203.14
Amendment Number n/a
I, Stephen Y. Carnell ,attest that no changes or revisions have been made to the
(Recipient/Contractor representative)
content of the above referenced agreement/contract or amendment between the Area Agency on Aging for
Southwest Florida and
Public Services Administrator
(Signature of Recipient/Contractor name)
The only exception to this statement would be for changes in page formatting,due to the differences in
electronic data processing media,which has no affect on the agreement/contract content.
6)„,
,A
I July 31, 2014
Signature of Recipient Contractor representative Date